Caring for a person with dementia (PWD) has been found to be associated with a variety of negative changes in health and well-being. Much of this research, however, has been correlational, with data gathered at one or two points in time, which can blur the sequence of events and thus the underlying mechanism by which stressors may affect health. New design approaches that use intensive repeated measurement of individuals offer the potential for clarifying the sequence of events from stressors to health markers and well-being and to establish more precisely the short-term health effects of concrete daily experiences The proposed study will collect daily diary data over a 9-day period on daily stressors, daily mood and health symptoms and daily measures of three critical biomarkers to demonstrate the links between stress and health, as well as possible mediators of that relationship. In contrast to prior daily diary studies, where the range of exposure to stressors is limited, we will take advantage of a naturally-occurring experiment by comparing the stress responses of caregivers using Adult Day Services (ADS) for their relative on days they use ADS and days they do not. Prior work by our group found that caregivers experienced a 66 percent reduction in exposure to care-related stressors on days they used ADS compared to non-ADS days. Comparable to the classic A-B-A research design, this approach will enable us to examine immediate as well as delayed effects of stressors under high and low stress conditions. The sample will be 180 family caregivers of a PWD who is currently using ADS. Participants will be assessed over a period of 9 consecutive days, including when their relative uses ADS (low stress days) and when their relative does not (high stress days). Daily measures include care-related and non-care stressors, subjective distress and health symptoms. Biomarkers will be obtained from saliva samples provided at scheduled times during each day. Assays will be obtained for 3 key biomarkers with implications for health: cortisol, alphaamylase and dehydroepiandrosterone- sulfate (DHEA-S). The results of the study will clarify the relation among daily stressors, well- being and biomarkers of health, and suggest the pathways by which caregiving stressors might affect health. The finding that stress responses are lower when exposure to stressors is reduced would also yield practical information on how caregiver services could reduce health risks. PUBLIC HEALTH RELEVANCE: It is widely recognized that the stress associated with caring for a person with dementia (PWD) is associated with a variety of negative outcomes for health and well-being. The proposed study will examine the links among daily stressors, well-being and biomarkers of health on high stress exposure and low stress exposure days. This approach will help us identify the pathways by which caregiving stress might affect health and may also yield practical information on the design of caregiver services that reduce stress exposure and their associated health risks.